Browsing by Author "Marambe, K."

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Clinical reasoning and its challenges at workplace: A qualitative study with novice medical graduates in Sri Lanka
(Staff Development Center, University of Kelaniya, Sri Lanka, 2015) Karunaratne, W.C.D.; Chandratilake, M.B.N.; Marambe, K.
Background and rationale: Clinical reasoning is a major determinant of clinical competence among medical professionals (Barrows & Feltovich, 1987). However, even after 40 years of research, diverging opinions still persist on the diagnostic decision making process adopt by medical professionals proving the complexed nature of the phenomenon (Eva, 2004). Aim: This study aims to explore how novice medical graduates working at four main clinical specialties (medicine, surgery, paediatrics and obstetrics & gynaecology) learn and perform clinical reasoning during internship training and the challenges encountered. Theoretical underpinning: Theories of diagnostic decision making range from hypotheticodeductive reasoning described in 1970’s to the dual process theory, discussed recently in the medical education literature (Norman, 2005; Pelaccia, Tardif, Triby, & Charlin, 2011). Proposed methodology: Interpretive paradigm research using phenomenology will be conducted on novice medical graduates working in medicine, paediatric, surgery and obstetrics & gynaecology wards at the North Colombo Teaching Hospital, Ragama, Sri Lanka. The study will be conducted in two phases using purposive sampling (a combined total of 16) with gender balance and equal representation of specialties. During the study each participant will undergo three (3) interviews. The first interview will be on their experience of clinical reasoning as an intern and the challenges faced. The subsequent two interviews are based on audio-recorded patient encounters using the technique of stimulated recall. Two experts from each specialty will review the audio-recordings of patient encounters and determine the relevance of questions to the diagnosis. The interviews will be anonymised and transcribed verbatim. A coding framework will be developed using the five-stage process proposed by Ritchie &Spencer (Analyzing qualitative data, 1994). Thematic analysis of the data will be done using ATLASti. Expected outcomes: The study findings will provide meaningful insights in to organizing and re-structuring medical internship training to facilitate learning and on measures for improving clinical reasoning during undergraduate medical training.
Learning clinical reasoning skills during the transition from a medical graduate to a junior doctor
(Centre Medical Education, 2024) Karunaratne, D.; Chandratilake, M.; Marambe, K.
INTRODUCTION: The literature confirms the challenges of learning clinical reasoning experienced by junior doctors during their transition into the workplace. This study was conducted to explore junior doctors' experiences of clinical reasoning development and recognise the necessary adjustments required to improve the development of clinical reasoning skills. METHODS: A hermeneutic phenomenological study was conducted using multiple methods of data collection, including semistructured and narrative interviews (n=18) and post-consultation discussions (n=48). All interviews and post-consultation discussions were analysed to generate themes and identify patterns and associations to explain the dataset. RESULTS: During the transition, junior doctors’ approach to clinical reasoning changed from a ‘disease-oriented’ to a ‘practiceoriented’ approach, giving rise to the ‘Practice-oriented clinical skills development framework’ helpful in developing clinical reasoning skills. The freedom to reason within a supportive work environment, the trainees’ emotional commitment to patient care, and their early integration into the healthcare team were identified as particularly supportive. The service-oriented nature of the internship, the interrupted supervisory relationships, and early exposure to acute care settings posed challenges for learning clinical reasoning. These findings highlighted the clinical teachers' role, possible teaching strategies, and the specific changes required at the system level to develop clinical reasoning skills among junior doctors. CONCLUSION: The ‘Practice-oriented clinical skills development framework’ is a valuable reference point for clinical teachers to facilitate the development of clinical reasoning skills among junior doctors. In addition, this research has provided insights into the responsibilities of clinical teachers, teaching strategies, and the system-related changes that may be necessary to facilitate this process.
Perspectives on the impact of COVID-19 pandemic on medical education: facing the challenges and learning the lessons
(Sri Lanka Journal of Medicine, 2020) Marambe, K.; Chandratilake, M.; Ponnamperuma, G.
No abstract available
Sustainability of innovations in health professions education
(John Wiley & Sons, 2022) Ponnamperuma, G.; Olupeliyawa, A.; Chandratilake, M.; Marambe, K.
The history of health professions education is replete with innovations in curriculum, teaching and learning, and assessment. Some of these changes have stood the test of time, while others have faded away. Knowledge of the triggering factors that led to the rise and fall of these innovations is helpful when planning future educational innovations, as educators can evade the common pitfalls of unsustainable innovations. This chapter analyses the reasons behind the sustainability of major educational innovations and the demise of the others. In conclusion, the chapter draws on the past sustainability trends to elucidate the features that indicate the long-term viability of innovations in health professions education. Based on the trends in innovations observed throughout history, the chapter attempts to predict what the future holds. Toward this end, the role of technology is featured as a way out, given the possible future restrictions of social contact posed by situations such as the present pandemic.
Using hermeneutic phenomenology approach to explore how junior doctors learn clinical reasoning in practice
(Sri Lanka Medical Association, 2017) Karunaratne, W.C.D.; Chandratilake, M.; Marambe, K.
INTRODUCTION & OBJECTIVES: Hermeneutic phenomenology is a qualitative study design to understand individual learning experiences from the beholder’s perspective (phenomenology) while appreciating the subjective interpretation of them by the researcher with essential prejudices for understanding the concept (hermeneutic). Clinical reasoning is a multifaceted, dynamic, individualized and evolving construct. Therefore, how junior doctors learn clinical reasoning in practice was explored using this approach. The aim is to share this methodological experience with prospective researchers to be used for similar purposes. METHODS: A total of 18 junior doctors (Males: 7, Females: 11) from four major clinical disciplines participated in individual in-depth semi-structured interviews. Lived-experiences were encouraged more during the interviews than the perceptions complying with phenomenology. The interviews were audio-recorded, transcribed verbatim and analyzed according to the Ritchie and Spencer framework using the Atlas.ti software. The above framework was chosen to maximize the diversity of interpretation. Three personnel with the same academic background but different levels of experience developed the coding framework. This resulted in identification of codes from participants’ expressions (first-order constructs; layered by the researcher’s interpretations of these constructs (second-order constructs). The second-order constructs gave the impetus for emerging themes for the coding framework. Three frameworks of three coders were compared; consensus and deviations were included in developing the final coding framework. RESULTS: The framework revealed rich and diverse accounts of how junior doctors conceptualized clinical reasoning, the presence of numerous interpersonal and contextual factors driving, facilitating and supporting learning and also hindering the learning process. CONCLUSION: Hermeneutic phenomenology can be used effectively to understand complex phenomena like clinical reasoning.